Investigation of the potential association between the use of fluoxetine and occurrence of acute pancreatitis: a Danish register-based cohort study

BACKGROUND: There is currently conflicting evidence of the association between the use of selective serotonin reuptake inhibitors (SSRIs) and acute pancreatitis. The SSRI fluoxetine has been suspected to be the driver of this serious outcome. Therefore, this study aims to investigate the potential association between fluoxetine use and the occurrence of acute pancreatitis. METHODS: We conducted a nationwide cohort study using Danish register-based data from 1996 to 2016. The exposed group were new users of fluoxetine (1-year washout). The control subjects were new users of citalopram or SSRIs, excluding fluoxetine. The outcome was an incident diagnosis of acute pancreatitis with a 5-year washout. We used an intention-to-treat approach following patients for a maximum of 6 months. Cox regression analyses were performed, estimating hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age/sex, comorbidities and co-medications, using propensity score adjustment and matching. RESULTS: In the propensity score-matched analyses, 61 783 fluoxetine users were included. The incidence rates among users of fluoxetine and other SSRIs were 5.33 (3.05-8.66) and 5.36 (3.06-8.70) per 10 000 person-years, respectively. No increased risk of acute pancreatitis was identified following fluoxetine exposure compared with either citalopram [HR 1.00, 95% CI 0.50-2.00) or other SSRIs (0.76, 0.40-1.46). CONCLUSIONS: Fluoxetine use was not associated with an increased risk of acute pancreatitis compared with citalopram or other SSRIs. The absolute risk of acute pancreatitis was low and did not vary between different SSRIs. Further research is needed to determine whether there is a class effect on the risk of acute pancreatitis

The Exposome Approach in Allergies and Lung Diseases: Is It Time to Define a Preconception Exposome?

Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept

Parental occupational exposure pre- and post-conception and development of asthma in offspring

Background: While direct effects of occupational exposures on an individual's respiratory health are evident, a new paradigm is emerging on the possible effects of pre-conception occupational exposure on respiratory health in offspring. We aimed to study the association between parental occupational exposure starting before conception and asthma in their offspring (at 0-15 years of age). Methods: We studied 3985 offspring participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Their mothers or fathers (n = 2931) previously participated in the European Community Respiratory Health Survey (ECRHS). Information was obtained from questionnaires on parental job history pre- and post-conception which was linked to an asthma-specific job-exposure matrix (JEM). We assessed the association between parental occupational exposure and offspring asthma, applying logistic regression models, clustered by family and adjusted for study centre, offspring sex, parental characteristics (age, asthma onset, place of upbringing, smoking) and grandparents' level of education. Results: Parental occupational exposure to microorganisms, pesticides, allergens or reactive chemicals pre-conception or both pre- and post-conception was not related to offspring asthma; in general, subgroup analyses confirmed this result. However, maternal exposure both pre- and post-conception to allergens and reactive chemicals was associated with increased odds for early-onset asthma in offspring (0-3 years of age); odds ratio 1.70 (95% CI: 1.02-2.84) and 1.65 (95% CI: 0.98-2.77), respectively. Conclusions: This study did not find evidence that parental occupational exposure, defined by an asthma JEM before conception only or during pre- and post-conception vs non-exposed, was associated with offspring asthma.This work was supported by funding from The Faculty of Health, Aarhus University, Denmark [Project No. 240008], The Wood Dust Foundation [Project No. 444508795], The Danish Lung Association, the Swedish Heart and Lung Foundation, the Swedish Association Against Asthma and Allergy, the Swedish Association against Heart and Lung Disease, the Swedish Council for Working Life and Social Research, The Bror Hjerpstedt Foundation, The Vårdal Foundation for Health Care and Allergic Research, The Norwegian Research Council [project 135773/33], The Norwegian Asthma and Allergy Association, HelseVest Norway [Grant no. 911 631], NFR [Grant no. 214123, 230827/F20, 228174], The University of Iceland Research Fund, The Icelandic GP's Research Fund, The Estonian Science Foundation [Grant No. 4350], The Estonian Research Council [Grant no. PUT562], the Australian National Health Medical Research Council, Melbourne University, Sociedad Española de Neumologia y Cirugía Toracica, SEPAR Spain and Horizon2020 PHC1 [Grant no. 633212]. For more information, please see www.rhinessa.net. V.S. and C.S. are members of the COST BM1201 network. K.P. received a PhD scholarship from Aarhus University and the Danish Working Environment Research Fund, Denmark [Grant no. 17–2015–09/20150067134]. X.L. is supported by the Danish Council for Independent Research [Project No. DFF-5053-00156B]

Agreement of offspring-reported parental smoking status: the RHINESSA generation study

Background: With increasing interest in exposure effects across generations, it is crucial to assess the validity of information given on behalf of others. Aims: To compare adult’s report of their parent’s smoking status against parent’s own report and examine predictors for discrepant answers. Methods: We studied 7185 offspring (18-51 years) and one of their parents, n = 5307 (27-67 years) participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Information about parent’s smoking status during offspring’s childhood and mother’s smoking status during pregnancy was obtained by questionnaires from parents and their offspring. We calculated sensitivity, specificity and Cohen’s Kappa [κ] for agreement using parent’s own report as the gold standard. We performed logistic regression to examine if offspring’s sex, age, educational level, asthma status, own smoking status or parental status, as well as the parent’s sex and amount of smoking during childhood predicted disagreement. Results: The sensitivity for offspring’s correct report of parent’s smoking status during childhood (0-10 years) was 0.82 (95% CI 0.81–0.84), specificity was 0.95 (95% CI 0.95–0.96) and a good agreement was observed, κ = 0.79 (95% CI 0.78–0.80). Offspring’s report of mothers’ smoking status during pregnancy showed a lower sensitivity, 0.66 (95% CI 0.60–0.71), a slightly lower specificity, 0.92 (95% CI 0.90–0.95) and a good agreement, κ = 0.61 (95% CI 0.55–0.67). In multivariate logistic regression analysis, offspring not having children was a predictor for discrepant answers (odds ratio [OR] 2.11 [95% CI 1.21–3.69]). Low amount of parents’ tobacco consumption, < 10 cigarettes/day (OR 2.72 [95% CI 1.71–4.31]) also predicted disagreement compared to ≥10 cigarettes per day, and so did offspring’s reports of fathers’ smoking status (OR 1.73 [95% CI 1.09–2.74]) compared to mothers’ smoking status. Offspring’s sex, asthma status, educational level, smoking status or age was not related to discrepant answers. Conclusions: Adults report their parent’s smoking status during their childhood, as well as their mother’ smoking status when pregnant with them, quite accurately. In the absence of parents’ direct report, offspring’s reports could be valuable

A comparison of work environment, job insecurity, and health between marginal part-time workers and full-time workers in Denmark using pooled register data

OBJECTIVES: This study aimed to evaluate characteristics of the work environment, job insecurity, and health of marginal part‐time workers (8.0‐14.9 hours/week) compared with full‐time workers (32.0‐40.0 hours/week). METHODS: The study population included employees in the survey Work Environment and Health in Denmark (WEHD) in 2012, 2014, or 2016 (n = 34 960). Survey information from WEHD on work environment and health was linked with register‐based information of exposure based on working hours 3 months prior to the survey, obtained from the register Labour Market Account. Associations between marginal part‐time work and work environment and health were assessed using logistic regression models. RESULTS: Marginal part‐time workers reported less quantitative job demands, lower levels of influence at work, poorer support from colleagues and leaders, less job satisfaction and poorer safety, as well as more job insecurity. Results on negative social relations in the workplace and physical workload were more ambiguous. Marginal part‐time workers were more likely to report poorer self‐rated health, treatment‐requiring illness, and depressive symptoms compared with full‐time workers. Adjusting for characteristics of the work environment showed an indication of altered odds ratios for self‐rated health and depressive symptoms, whereas job insecurity did not. CONCLUSIONS: This study finds that marginal part‐time workers experience a poorer psychosocial work environment and safety, higher job insecurity, and poorer health than full‐time workers. Work environment characteristics may confound or mediate the association between marginal part‐time work and health. However, prospective studies are needed to determine the causal direction of the revealed associations

Labor Market Affiliation of Marginal Part-Time Workers in Denmark&mdash;A Longitudinal Study

This longitudinal study examined the labor market affiliations of marginal part-time workers (&lt;15 working hours/week) compared with full-time workers (32&ndash;40 working hours/week) within gender and age groups. Analyses were based on 1,492,187 Danish employees with marginal part-time or full-time work at baseline using register data of working hours and labor market affiliation from the Labor Market Account. We used the Expected Labor Market Affiliation method within gender and age groups to estimate the time spent in different labor market states over a 5-year follow-up from 2012&ndash;2017. The multistate model included five recurrent labor market states: work, unemployment, long-term sickness absence, studying, and temporarily out, and the results were adjusted for education level, morbidity, and ethnicity. A marginal part-time worker generally had fewer days of work without social benefits and spent more days studying during follow-up compared with a full-time worker. In addition, marginal part-time workers &ge; 25 years old had more days of unemployment and more days of long-term sickness absence. These findings suggest that marginal part-time workers have fewer paid workdays without social benefits compared with full-time workers, depending on age. Further studies should explore whether marginal part-time work is a stepping stone into or out of the labor market